Home Health & Hospice Week

CMS finalizes Medicaid F2F rule.

If you got passed over in MAC’s initial face-to-face “Probe & Educate” medical review round, your fate is still uncertain.

The Centers for Medicare & Medicaid Services announced in a November MLN Matters article that HHH Medicare Administrative Contractors would select five claims from “each HHA” in their jurisdiction to review under the initiative focused on the physician F2F encounter (see Eli’s HCW, Vol. XXIV, No. 40). CMS expected the P&E claims requests to start as early as October, although the MACs appear to have sent them more recently.

But at least one MAC has admitted to missing some HHAs in that first round, according to a caller in the Jan. 27 Open Door Forum for home health. The agency wanted to know whether those missed HHAs would be included in the second round, which will address those HHAs who fell into the “Moderate/Major Concerns” category when reviewers found problems with two or more claims in the five-claim sample from the first round. CMS said it didn’t have the staff on the call to answer the question, so those skipped agencies will have to stay tuned to discover their fate.

Resource: The MLN Matters article outlining the P&E process is at www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1524.pdf.

Meanwhile, CMS published its final rule on Medicaid F2F requirements in the Feb. 2 Federal Register. The rule, which takes effect July 1, “clarifies that Medicaid home health services and items are not limited to home settings,” among other things, CMS says in the notice at www.gpo.gov/fdsys/pkg/FR-2016-02-02/pdf/2016-01585.pdf.